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Colorectal > Carcinoma of the Colon, Rectum and Anus > Flashcards

Carcinoma of the Colon, Rectum and Anus Flashcards

1
Q

What are the risk factors for colorectal carcinoma?

A 
Family history
Age
Low dietary fibre/high fat diet (western)
UC
Smoking
Obesity
Alcohol
Sedentary lifestyle
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2
Q

What are the protective factors for colorectal carcinoma?

A

Fibre consumption
Exercise
HRT
Aspirin/NSAIDs

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3
Q

What is the genetic component contributing to colorectal carcinoma?

A

Familial adenomatous polyposis (FAP)

Hereditary non-polyposis colorectal cancer (HNPCC)

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4
Q

Describe FAP

A

Responsible for <1% of cancers
Due to tumour suppressor gene APC mutations

Causes excess polyp formation within the colon which turn cancerous by age 40

People normally have pan colectomy with ileo-anal pouch formation in their 20s to prevent this

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5
Q

Describe HNPCC

A

Responsible for <5% of cancers
Germline mutations in mismatch repair genes

Predisposes patients to cancer especially colonic
Often affects proximal colon and is poorly differentiated

Can also cause other cancers such as endometrial

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6
Q

What cancer morphology is typical of colorectal carcinomas?

A

Adenocarcinomas (signet rings)

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7
Q

Where do most colorectal carcinomas occur?

A 
Caecum & Ascending Colon - 15%
Transverse Colon - 10%
Descending Colon - 5%
Sigmoid Colon - 25%
Rectum - 45%
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8
Q

How do colorectal carcinomas first develop?

A

Polypoid mass w/ ulceration

Initial spread by bowel wall infiltration

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9
Q

How do colorectal carcinomas typically spread?

A

Through lymphatics/blood vessels
Metastasise to Liver primarily
Can spread transcoelomically

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10
Q

What are the common symptoms suggesting colorectal carcinoma?

A 
Change in bowel habit
Abdo pain
Iron deficient anaemia
Weight loss
Rectal bleeding
Rectal or abdo mass
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11
Q

How do R-sided colorectal carcinomas typically present?

A

Often asymptomatic

May present w/ Iron deficient anaemia/weight loss

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12
Q

How do L-sided colorectal carcinomas typically present?

A 
PR blood/mucus
Altered bowel habit
Tensemus
Obstruction
Mass on PR exam
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13
Q

How do anal carcinomas typically present?

A 
Bleeding
Pain
Altered bowel habit
Pruritis ani
Masses/stricture
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14
Q

Describe Duke’s staging of colorectal carcinoma

A

Duke’s A - Tumours invade submucosa +/- muscularis propria
Duke’s B - Tumours invade past muscularis proria but no nodal involvement
Duke’s C - Regional lymph node involvement
Duke’s D - Distant metastases

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15
Q

What is the most common morphology of anal cancers?

A

SCC

Affect 1200 people/yr in the UK

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16
Q

What are the risk factors for anal cancer?

A

Anoreceptive sex
Syphillis infection
Anal warts/cervical cancer (HPV)
Immunosuppression

17
Q

What is the pectinate line?

A

Embryological division b/w upper 2/3 and lower 1/3 of anal canal

18
Q

What are the features of anal tumours above the pectinate line?

A 
Columnar epithelium
Lymph drainage to internal iliac nodes
Portal venous drainage (hepatic mets)
More common in women
Worse prognosis
19
Q

What are the features of anal tumours below the pectinate line?

A 
Squamous epithelium
Lymph drainage to superficial inguinal nodes
Caval venous drainage (pulmonary mets)
More common in men
Better prognosis
20
Q

What are the indications for a 2WW referral in pts >40?

A

Unintentional weight loss AND abdominal pain

21
Q

What investigations are appropriate in suspected colorectal carcinoma?

A

Bloods - FBC (microcytic anaemia?) LFTs (mets)
Colonoscopy +/- biopsy/polypectomy
CT chest, abdo, pelvis
Carcino-embryonic antigen- helps predict risk of relapse
Sigmoidoscopy if just rectal bleeding
Colonography if patient not fit for colonscopy

22
Q

What are the surgical options for treating colorectal carcinoma?

A 
Right hemicolectomy
Left hemicolectomy
Sigmoid colectomy (high anterior)
Anterior resection
Abdomino-perineal resection
Hartmann's procedure
23
Q

What are the appropriate tumour sites for a right hemicolectomy?

A

Caecal
Ascending
Proximal transverse

24
Q

What are the appropriate tumour sites for a left hemicolectomy?

A

Distal transverse

Descending

25
Q

What are the appropriate tumour sites for a high anterior resection?

A

Sigmoid

26
Q

What are the appropriate tumour sites for an anterior resection?

A

Low sigmoid

High rectal

27
Q

What are the appropriate tumour sites for an abdomino-perineal resection?

A

Tumours low in rectum

28
Q

What are the indications for Hartmann’s procedure?

A

Bowel obstruction

Palliation

29
Q

What are the indications for Endoscopic stenting?

A

Palliation

30
Q

How is radiotherapy used to treat colorectal cancer?

A

Pre-op to reduce recurrence/increas survival

Post-op if high risk of local recurrence

31
Q

What is the main complication of radiotherapy in colorectal cancer?

A

High risk of post-op complications

  • DVT
  • pathological fractures
  • fistula formation
32
Q

How is chemotherapy used to treat colorectal cancer?

A

Adjuvant 5-FU (and folic acid) to reduce mortality of high stage tumours
Palliation of metastatic disease

33
Q

What is the management strategy for anal carcinomas?

A

Radiotherapy & chemotherapy

-75% retain normal anal function

34
Q

What do all patients undergoing CRC surgery require?

A

Colonoscopy before/soon after

-5% tumours have multiple primaries

35
Q

Describe the follow up programme for CRC pts

A

Pts w/ stage II/III disease

  • serum CEA every 3mo
  • colonoscopy every 3yrs
36
Q

What are the management options for an obstructing colonic cancer?

A 
A-E resus
Analgesia/NG tube decompression
AXR/erect CXR
CT
Gastrograffin
DEFINITIVE SURGERY/ENDOSCOPIC STENTING

Colorectal (7 decks)

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